- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $97.72 / $251.19 / $416.87
| Facility | | $97.72 | $251.19 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $7.94 / $7.94
| Facility | 26 | $7.94 | $7.94 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $25.12 / $37.15 / $245.47
| Facility | TC | $25.12 | $37.15 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $18.20 / $30.90 / $69.18
| Professional | | $18.20 | $30.90 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.24 / $9.77 / $30.20
| Professional | 26 | $7.24 | $9.77 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $21.88 / $27.54 / $69.18
| Professional | TC | $21.88 | $27.54 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $56.23 / $194.98
| Facility | | $32.36 | $56.23 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $27.54 / $42.66 / $56.23
| Professional | | $27.54 | $42.66 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $60.26 / $75.86 / $95.50
| Professional | | $60.26 | $75.86 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.80 / $17.38 / $21.88
| Professional | 26 | $13.80 | $17.38 | $21.88 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $58.88 / $74.13
| Professional | TC | $46.77 | $58.88 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $47.86 / $69.18
| Facility | | $35.48 | $47.86 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $43.65 / $204.17
| Professional | | $28.84 | $43.65 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $14.13 / $74.13
| Professional | 26 | $8.32 | $14.13 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $33.11 / $177.83
| Professional | TC | $20.42 | $33.11 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $66.07 / $67.61
| Professional | | $61.66 | $66.07 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $15.49 / $16.22 / $19.50
| Professional | 26 | $15.49 | $16.22 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $52.48
| Professional | TC | $46.77 | $46.77 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $64.57 / $64.57
| Professional | | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $17.38 / $17.38 / $17.38
| Professional | 26 | $17.38 | $17.38 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $46.77 / $46.77 / $46.77
| Professional | TC | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $35.48 / $46.77 / $61.66
| Professional | | $35.48 | $46.77 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $9.77 / $13.18 / $15.49
| Professional | 26 | $9.77 | $13.18 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $24.55 / $34.67 / $46.77
| Professional | TC | $24.55 | $34.67 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $31.62 / $48.98 / $72.44
| Professional | | $31.62 | $48.98 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.71 / $14.13 / $20.89
| Professional | 26 | $8.71 | $14.13 | $20.89 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $22.91 / $35.48 / $53.70
| Professional | TC | $22.91 | $35.48 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $54.95 / $64.57 / $64.57
| Professional | | $54.95 | $64.57 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $13.18 / $15.49 / $15.49
| Professional | 26 | $13.18 | $15.49 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $41.69 / $48.98 / $48.98
| Professional | TC | $41.69 | $48.98 | $48.98 |